Sources of Concern about the Patient Self-Determination Act

Wolf, Susan M.; Boyle, Philip; Callahan, Daniel; Fins, Joseph J.; Jennings, Bruce; Nelson, James Lindemann; Barondess, Jeremiah A.; Brock, Dan W.; Dresser, Rebecca; Emanuel, Linda L.; Johnson, Sandra H.; Lantos, John D.; Mason, DaCosta; Mezey, Mathy; Orentlicher, David; Rouse, Fenella

doi:10.1056/nejm199112053252334

Cited by 140 publications

(45 citation statements)

References 35 publications

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“…10e12 An AD is a legal document that outlines a person's care preferences and wishes, should their decision-making ability be diminished as a result of a critical illness or cognitive impairment. 13,14 Unlike other parts of the developed world (ie, United States, 15 Netherlands, 16 Australia, 12 United Kingdom, 11 and Singapore 17 ), the concept of AD is still relatively new in mainland China. However, in other parts of China, there is growing interest and concern about the need for better end-of-life care for terminally ill older patients, which is reflected in various recent policy initiatives.…”

Section: O P Ymentioning

confidence: 99%

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Zhou

Wang

et al. 2014

Journal of the American Medical Directors Association

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Objectives: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-oflife care preferences and to explore the predictors of their preference for AD. Design: Population-based cross-sectional survey. Settings: Nursing homes (n ¼ 31) in Wuhan, Mainland Southern China. Participants: Cognitively intact nursing home residents (n ¼ 467) older than 60 years. Measures: Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. Results: Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about lifesustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). Conclusions: Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.With the aging of China's population, the demand for nursing home care is increasing.1 In Wuhan, a southern city in Hubei province, Mainland China, there are approximately 9.79 million people.

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Section: O P Ymentioning

confidence: 99%

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Zhou

Wang

et al. 2014

Journal of the American Medical Directors Association

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“…The results showed that conservative therapy (ICT followed by radiation) is just as effective as surgical therapy alone [63] . Thus, the use of ICT should determine potential nonresponders to radiation in order to prevent the typical complications of salvage laryngectomy [50] .…”

Section: Response To Induction Chemotherapy As a Predictive Markermentioning

confidence: 99%

Response Evaluation in Head and Neck Oncology: Definition and Prediction

Hoffmann¹,

Schuler²,

Laban³

et al. 2017

ORL

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Curative treatment of head and neck squamous cell carcinoma includes surgery and/or (chemo)radiation, whereas in the palliative setting, chemotherapy and/or immunotherapy represent(s) the standard approach. With regard to quality control, methods for determining treatment response are sorely needed. For surgical therapy, histopathology is the standard quality control. Established criteria for high-risk patients include resection margins of the primary tumor and extracapsular extension of lymph node metastases. After definitive chemoradiation, treatment response is generally evaluated by tomographic imaging combined with endoscopy including re-biopsy of the tumor region. Single-cycle induction chemotherapy may be used to determine the radiosensitivity of tumors, helping to define surgical and nonsurgical treatment options. Innovative approaches with implications for prognosis include the analysis of immune infiltrates, liquid biopsy, molecular characterization (proteomics, genomics), molecular and functional imaging (PET-CT, PET-MRI), as well as advanced imaging data analysis (radio[geno]mics/texture analysis). Human papilloma virus, as a prognostically relevant parameter, is currently being investigated for de-escalation strategies. With regard to the extended personalization of oncologic therapy, markers predicting treatment response are desirable and seem to be important, also from a socioeconomic perspective.

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“…The federal 1990 Patient Self-Determination Act increased dramatically the proportion of nursing home residents for whom a surrogate is identified to make medical decisions if the resident loses medical decision-making capacity [22]. While it might be the surrogate decision maker's responsibility to render a decision about a resident's sexual activity if he or she lacks capacity, this does not obviate the need for a careful capacity assessment that would help guide the surrogate decision maker in arriving at this decision.…”

Section: Surrogate Decision Makersmentioning

confidence: 99%

Ethics and Intimate Sexual Activity in Long-Term Care

2017

AMA Journal of Ethics

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A case is presented in which the staff of a long-term care facility discovers that the husband of a resident with dementia is engaged in sexual activity with her. The case illustrates a dilemma for long-term care facilities that create a home-like environment with a goal of maximizing residents' autonomy while ensuring their safety. An approach to assessing capacity to consent to intimate sexual activity is described, followed by guidelines that nursing homes can implement to support residents who wish to engage in sexual activity. Recommendations are also offered for supporting long-term care staff and family members of residents who are interested in intimate sexual activity. CaseAs a second-year psychiatry resident, Dr. Brian is working in a long-term care facility during his geriatric psychiatry rotation. The facility is structured to accommodate residents' escalating needs with various levels of care, ranging from independent living to assisted living to nursing home. Dr. Brian is working with a geriatric psychiatrist, Dr. Anderson, whose main role in the long-term care facility is to provide psychiatric consultation.One afternoon, Drs. Brian and Anderson receive a consultation request regarding Mrs. Shera, an 80-year-old woman living in the nursing home section who has dementia. When reviewing her record, Dr. Brian sees that she was admitted to the long-term care facility about six months ago, after living independently with her husband of 55 years. Over time, it became more difficult for him to manage some of her behavioral issues at home. For instance, when she would take walks through the woods near their house, she would get lost on the paths. Sometimes, the police were called to search for her and take her home. When Mr. Shera tried to limit her excursions, she would become severely irritable, yelling at him and ultimately swinging at him when he tried to keep her from leaving the house. These episodes would last about 5-10 minutes, at which point Mrs. Shera would shut down and then forget what had just happened.In the nursing home, Mr. Shera visited her as much as he could and she was always happy to see him. Once, a nurse walked into Mrs. Shera's room and found her and her

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Sources of Concern about the Patient Self-Determination Act

Cited by 140 publications

References 35 publications

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Response Evaluation in Head and Neck Oncology: Definition and Prediction

Ethics and Intimate Sexual Activity in Long-Term Care

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